HomeMy WebLinkAboutStudent Affiliation Agrmt - OHSU - Health Dept (2)Deschutes County Board of Commissioners
1300 NW Wall St., Suite 200, Bend, OR 97701-1960
(541) 388-6570 - Fax (541) 385-3202 - www.deschutes.org
AGENDA REQUEST & STAFF REPORT
For Board Business Meeting of June 25, 2008
Please see directions for completing this document on the next page.
DATE: June 16, 2008
FROM: Dan Peddycord. Health Department 322-7478
TITLE OF AGENDA ITEM:
Review and approval of document number 2008-351 - the Student Affiliation Agreement Amendment 3
to the Student Affiliation Agreement AFF -2005-0097 between Oregon Health and Science University
(OHSU) and Deschutes County health department extending the time period of the agreement to June
30, 2009.
PUBLIC HEARING ON THIS DATE? No.
BACKGROUND AND POLICY IMPLICATIONS:
This Student Affiliation Agreement Amendment 3 is to extend the term of the agreement to June 30,
2013 with all terms and agreements remaining the same.
This agreement provides for undergraduate and/or graduate level nursing students will be participating
in clinical experiences under supervision at the Deschutes County health department.
Starting Date: July 1, 2008 Ending Date: June 30, 2009
FISCAL IMPLICATIONS:
None.
RECOMMENDATION & ACTION REOUESTED:
Approval and signature of Student Affiliation Agreement Amendment 3 to agreement AFF -2005-0097
between Oregon Health and Science University (OHSU) and Deschutes County health department for
the period: July 1, 2008 to June 30, 2009 is requested.
ATTENDANCE: Dan Peddycord
DISTRIBUTION OF DOCUMENTS:
Dakota Duncan, Contracts Coordinator, OHSU School of Nursing, 3455 SW US Veterans Hospital
Road, SN -ADM Portland, Oregon 97239-2941, (503) 418-3256, Fax: (503) 494-4350,
duncand@ohsu.edu; and Jill Fox, 322-7478, Health Department, 2577 NE Courtney Drive, Bend,
Oregon 97701.
DESCHUTES COUNTY DOCUMENT SUMMARY
(NOTE: This form is required to be submitted with ALL contracts and other agreements, regardless of whether the document is to be
on a Board agenda or can be signed by the County Administrator or Department Director. If the document is to be on a Board
agenda, the Agenda Request Form is also required. If this form is not included with the document, the document will be returned to
the Department. Please submit documents to the Board Secretary for tracking purposes, and not directly to Legal Counsel, the
County Administrator or the Commissioners. In addition to submitting this form with your documents, please submit this form
electronically to the Board Secretary.)
Date:
Please complete all sections above the Official Review line.
June 16, 2008
Contact Person:
Dan Peddycord
Contractor/Supplier/Consultant Name:
Department:
Health Department
Phone #:
322-7426
Dakota Duncan, Contracts Coordinator,
OHSU School of Nursing, 3455 SW US Veterans Hospital Road, SN -ADM Portland,
Oregon 97239-2941, (503) 418-3256, Fax: (503) 494-4350
Goods and/or Services: Review and approval of document number 2008-351 - the
Student Affiliation Agreement Amendment 3 to the Student Affiliation Agreement AFF -
2005 -0097 between Oregon Health and Science University (OHSU) and Deschutes
County health department extending the time period of the agreement to June 30, 2009.
Background & History:
This Student Affiliation Agreement Amendment 3 is to extend the term of the agreement
to June 30, 2009 with the all terms and agreements remaining the same.
Undergraduate and/or graduate level nursing students will be participating in clinical
experiences under supervision at the Deschutes County health department.
Agreement Starting Date:
2009
July 1, 2008
Annual Value or Total Payment:
None.
❑ Insurance Certificate Received (check box)
Insurance Expiration Date:
Check all that apply:
❑ RFP, Solicitation or Bid Process
❑ Informal quotes (<$150K)
® Exempt from RFP, Solicitation or Bid Process (specify — see DCC §2.37)
Funding Source: (Included in current budget? ❑ Yes ❑ No A \-
If
No, has budget amendment been submitted? ❑ Yes ❑ No
N/A
Ending Date:
June 30,
Departmental Contact:
Title:
Kate Moore
Manager, Maternal Child Health
Phone #:
322-7422
6/16/2008
Department Director Approval:
‘/r�loef
Signture Date
Distribution of Document: Include complete information if document is to be mailed.
Official Review:
County Signature Required (check one): E BOCC E Department Director (if <$25K)
❑ Administrator (if >$25K but <$150K; if >$150K, BOCC Order No.
Legal Review Date
Document Number
)
6/16/2008
Contract #AFF -2005-0097
Amendment #3
AMENDMENT #3
AFFILIATION AGREEMENT
Between
OREGON HEALTH AND SCIENCE UNIVERSITY
SCHOOL OF NURSING
and
DESCHUTES COUNTY HEALTH DEPARTMENT
1. This Agreement is between Oregon Health and Science University, an Oregon statutory public corporation, School
of Nursing, hereinafter called OHSU, and Deschutes County Health Department, hereinafter called AGENCY.
2. This is Amendment number 3 to original Agreement number AFF -2005-0097.
3. The Agreement originally entered into between OHSU and AGENCY shall be amended as follows:
The term of this agreement shall be from July 1, 2008 to June 30, 2009.
4. In approving this Amendment, it is understood and agreed that all other terms and conditions of the original
Agreement are still in effect.
Dated (by last signatory) this day of , 2008.
OREGON HEALTH AND SCIENCE UNIVERSITY
3181 SW Sam Jackson Park Road
Portland, OR 97239-3098
DESCHUTES COUNTY HEALTH DEPARTMENT
2577 NE Courtney
Bend, OR 97707
Ofc: (503) 494-3272 Ofc: 541-322-7400
Fax: (503) 494-6937
../E2Ja12 617t0i
Christyne Belden Date Dan Peddycord/' Date
Contracts Coordinator Director
Saundra L. Theis, PhD, RN Date
Professor & Interim Dean, School of Nursing
BOARD OF COUNTY COMMISSIONERS OF
DESCHUTES COUNTY, OREGON
DENNIS R. LUKE, Chair
TAMMY MELTON, Commissioner
MICHAEL M. DALY, Commissioner
ATTEST:
Recording Secretary
AMENDMENT #2
AFFILIATION AGREEMENT
Between
OREGON HEALTH AND SCIENCE UNIVERSITY
SCHOOL OF NURSING
and
DESCHUTES COUNTY HEALTH DEPARTMENT
Contract #AFF -2005-0097
Amendment #2
1. This Agreement is between Oregon Health and Science University, an Oregon statutory public corporation, School
of Nursing, hereinafter called OHSU, and Deschutes County Health Department, hereinafter called AGENCY.
2. This is Amendment number 2 to original Agreement number AFF -2005-0097.
3. The Agreement originally entered into between OHSU and AGENCY shall be amended as follows:
The term of this agreement shall be fromJuly 1, 2007 to June 30, 2008.
4. A new section shall be added to the current agreement:
2 (I) Criminal History Background Checks: Students and interns placed for training within the Pubic
Health workforce will be appropriately screened for past criminal activity consistent with OAR 410-
007-0200. It is the duty of OHSU to assure for the fitness and suitability of students placed in
AGENCY relative to any past criminal activity. OHSU will conduct a criminal history background
check on students prior to placement for student training in the AGENCY only those applicants
who receive a Pass are reviewed further for admission to OHSU. Should AGENCY requve
additional information on the results of the background checks, AGENCY may contact the student
for those results, and/or AGENCY may perform its own additional criminal background check at
AGENCY's expense.
5. In approving this Amendment, it is understood and agreed that all other terms and conditions of the original
Agreement are still in effect.
Dated (by last signatory) this
day of
, 2007.
OREGON HEALTH AND SCIENCE UNIVERSITY
3181 SW Sam Jackson Park Road
Portland, OR 97239-3098
Ofc: (503) 494-3272
Fax: (503) 494-6937
Christyne Beln
Contracts Coordinator
a
alf
DESCHUTES COUNTY HEALTH DEPARTMENT
2577 NE Courtney
Bend, OR 97707
Ofc: 541-322-7400
6/7/07
Daniel W. PeddycgfyV Date
Director
"q-12-07- 1/e, (r 0
�
Saunda L. T eis, PhD, ' Date ate
f t Professor & I -rim D- = chool of Nursing Michael M. Daly hair
Deschutes County Board of Commissioners
Contract #AFF -2005-0097
Amendment #1
AMENDMENT #1
AFFILIATION AGREEMENT
Between
OREGON HEALTH & SCIENCE UNIVERSITY
SCHOOL OF NURSING
and
DESCHUTES COUNTY HEALTH DEPARTMENT
1. This Agreement is between Oregon Health & Science University, an Oregon public corporation, School of Nursing,
hereinafter called OHSU, and Deschutes County Health Department, hereinafter called AGENCY.
2. This is Amendment number 1 to original Agreement number AFF -2005-0097.
3. The Agreement originally entered into between OHSU and AGENCY shall be amended as follows:
The term of this agreement shall be from July 1, 2006 to June 30, 2007.
4. In approving this Amendment, it is understood and agreed that all other terms and conditions of the original
Agreement are still in effect.
Dated (by last signatory) this /=" day of
OREGON HEALTH & SCIENCE UNIVERSITY
3181 SW Sam Jackson Park Road
Portland, OR 97239-3098
Ofc: (503) 494-5075
Fax: (503) 494-6937
CIAZA,Q r � /ict.J �/F/f76
, 2006.
DESCHUTES COUNTY HEALTH DEPARTMENT
2577 NE Courtney
Bend, OR 97707
Ofc: 541-322-7400
Christyne Belden Date Dan Peddycord
Contracts Coordinator — Director
lanai
Kathleen Potempa, DNSc, RN,
Dean, School of Nursing
Se4/040
7-ZY• ado
Date
Date
C:IDocuments and SettIngsyiIh Local SettIngsiTemporary Internet Files1OLK11Deschutes Co Health Dept Amendment 1.doc
Oregon Health & Science University
SCHUOL OF NURSING
PORTLAND CAMPUS
OHSU Contract # AFF -2005-0097
replaces N-1996-0029 !,
Mail code SN -ADM • 3455 S.W. U.S. Veterans Hospital Rd. • Portland, Oregon 97239-2941
TEL: 503 494-7100 • www.ohsu.edu/son
AFFILIATION AGREEMENT
FOR EDUCATION
Between
OREGON HEALTH & SCIENCE UNIVERSITY
SCHOOL OF NURSING
And
DESCHUTES COUNTY HEALTH DEPARTMENT
This is an Agreement between Oregon Health & Science University, School of Nursing, an Oregon public corporation (OHSU), an i
DESCHUTES COUNTY HEALTH DEPARTMENT (FACILITY).
TERM OF AGREEMENT
This Agreement will be effective upon the date of the last signature and will continue In effect through
June 30, 2006. Training cannot begin prior to the execution of this Agreement.
SCOPE OF TRAINING
To BE PROVIDED
NOTICES
Undergraduate and/or graduate level nursing students will be participating in clinical experiences under
the supervised training of FACILITY's preceptor, or other FACILITY appointed training supervisory
personnel.
Any notice required or permitted to be given pursuant to this agreement shall be given in writing and
address to the following:
OHSU:
FACILITY:
Contracting & Purchasing Services
Attn: Contract # AFF -2005-0097
Oregon Health & Science University
3930 SW Macadam Avenue
Portland, OR 97239
Ofc: 503-494-5075
Fax: 503-494-6937
Dan Pettycerd. Pt/J.14
Director
Deschutes County Health Department
2577 NE Courtney
Bend, OR 97707
Ofc: 541-322-7400
Kathleen Potempa, DNSc, RN, FMN
Dean, School of Nursing
Oregon Health & Science University
3181 SW Sam Jackson Park Road
Portland, OR 97239
Ofc: 503-418-3256
Fax: 503-494-3400
Name
Title
Department
Facility Name
Facility Address
City, St, Zip
Ofc:
Fax: -
REQUIRED
FEDERAL TAx ID
OHSU:
FACILITY:
H:tPractice Development1My Documents - PDIDeschutes County Helath Dept. agr 04.doc Page 1 of 6
STANDARD TERMS AND CONDITIONS
1. DEFINITIONS
OHSU Contract N AFF -2005-0097
replaces N-1996-0029
"OHSU" is Oregon Health & Science University,
"FACILITY" is the agency with whom OHSU is contracting for clinical training.
"Trainees" are any students, residents or fellows receiving clinical instruction/training,
"Training Site" Is the location at which the Trainees are receiving clinical Instruction/training.
"Sending Site" is whichever agency ("OHSU" or "FACILITY") is sending their Trainees (students, residents, fellows) to the
"Training Site" for clinical instruction/training.
"HIPAA" Is Health Insurance Portability and Accountability Act.
"PHI" is Protected Health Information.
2. MUTUAL RESPONSIBILITIES OF OHSU AND FACILITY
a) The parties agree to cooperate In the provision of clinical experiences for Trainees at Training Site at no cost tc the
Sending Site.
b) The number of Trainees at Training Site and the amount of clinical supervision to be exercised by faculty, staff, employees
of Training Site during each quarter of the school year shall be mutually agreed upon by the parties prior to the start of the
clinical learning experience. The parties shall mutually agree upon utilization, selection and role of preceptors, as well as
the dates and times of the Trainees' experiences and other Information to be provided by the Sending Site relative to the
Trainees and their learning experience.
c) It Is understood that circumstances may arise affecting either party which would prevent placement of Trainees at the
Training Site during any particular quarter of the school year.
d) Nothing in this agreement Is Intended to create an employer/employee relationship between the Trainees, OHSU, and/or
FACILITY.
e) Sending Site will assign clinical faculty to be responsible for the Trainees' educational experience at Training Site, and will
plan cooperatively with Training Site for appropriate orientation of faculty and Trainees.
f) Sending Site will plan for the learning experiences of its Trainees to include case selection, hours for class and laboratory
practice, course content, methods of teaching, and evaluation of Trainees' programs in meeting course objectives.
g) Sending Site will also be responsible for all personal and academic records of the Trainees and will furnish names and
other Trainee data as mutually agreed upon and to the extent allowed under student record laws and regulations.
h) Sending Site's faculty members responsible for the clinical supervision of Trainees will meet as needed with approprate
Training Site personnel and Interpret the Trainee programs.
I) Sending Site will notify each its Trainees of the following responsibilities:
(1) To abide by the policies, procedures, practices, rules and regulations of the Training Site which are In effect when
Trainees are at the Training Site, as identified by the Training Site to the Sending Site.
(2) Upon enrollment and as a condition of enrollment In the program, to provide proof of up-to-date immunizations of
Diphtheria, Tetanus, Polio, Rubella, Rubeola, Hepatitis B or proof of prior disease, yearly proof of tuberculin skin tests
and/or chest x-rays, CPR certification and Bloodbome Pathogen training.
(3) To keep In confidence any and all privileged information concerning patient/clients of the Training Site, and upon
request to provide proof of certification In HIPAA training at the Sending Site.
j) Training Site shall retain sole responsibility for its patients' care and treatment while Trainees are receiving clinical
experience at the Training Site.
k) Training Site may request Sending Site to remove from the Training Site, within five (5) days of receipt of notice, of any
Trainee who in the Training Site's judgment is not performing satisfactorily, or who refuses to follow Training Site's
administrative and patient care policies, procedures, rules, and regulations. Such requests must be In writing and must
include a statement of reason(s) why Training Site desires Sending Site to withdraw the Trainee, and shall include
consultation with the designated faculty member. However, If Trainee's performance endangers the health and welfare of
patients and/or employees of the Training Site, the Trainee will be withdrawn immediately by the Sending Site,
H:IPrectke DavelopmentlMy Documents - PDIDeschutes County Hefath Dept agr 04.doc......Page 2 016
OHSU Contract 0 AFF -2005-0097
replaces N-1996-0029
3. RELATIONSHIPS
OHSU and FACILITY intend that, under this contract, the relationship between OHSU and FACILITY is at all times and for all
purposes that of independent contractors. FACILITY is not to be considered an agent or employee of OHSU for any purpose, ,.3nd
neither FACILITY nor any of FACILITY's agents or employees are entitled to any of the benefits that OHSU provides for its
employees. FACILITY is not an officer, employee or agent of OHSU as those terms are used in ORS 30.265. OHSU is not to be
considered an agent or employee of FACILITY for any purpose, and neither OHSU nor any of OHSU's agents or employees are
entitled to any of the benefits that FACILITY provides for its employees. Each party is solely and entirely responsible for its acts and
the acts of its agents or employees during the performance of this contract. Nothing contained in thls Agreement shall be construed
to create a relationship of agency, representation, Joint venture, brokerage, partnership, ownership, control or employment between
the parties other than that of Independent parties contracting for the purpose of effectuating this agreement.
4. AUTHORIZATION TO PROVIDE SERVICES
By signing this Agreement, the OHSU's President, Provost, Vice President, or their designees authorize OHSU's Trainees to
provide patient care services pursuant to this Agreement the Training Site.
5. AMENDMENTS
The terms of this Agreement shall not be waived, altered, modified, supplemented or amended, in any manner whatsoever, except
by written instrument signed by both parties.
6. TERMINATION
The Agreement may be terminated by mutual consent of both parties, or by either party upon giving 30 days written notice to the
other party. Unless otherwise agreed to by both parties, such termination will be effective at the end of the then current academic
term in order to allow Trainees to complete their clinical experience. Such notice is to be delivered by certified mall or in person.
7. INDEMNIFICATION
,f OHSU's Trainees are being trained at FACILITY:
N FACILITY's Trainees are belna trained at OHSU:
FACILITY Is responsible for the care of its patients and under
OHSU Is responsible for the care of its patients and under this
this Agreement is providing training for OHSU Trainees at
Agreement is providing training for FACILITY Trainees at
FACILITY. FACILITY shall save, defend, indemnify, and hold
OHSU. Within the limitations of the Oregon Tort Claims Act
harmless OHSU and its Board of Directors, officers,
employees, and agents from all claims, suits, and actions of
any nature resulting from or arising out of the activities or
(ORS 30.260-30.300) OHSU shall save, defend, indemnify,
and hold harmless FACILITY and its Board of Directors,
officers, employees, and agents from all claims, suits, and
omissbns of any OHSU employees or agent acting within the
actions of any nature resulting from or arising out of the
scope of this Agreement, or from the activities or omissions of
activities or omissbns of any FACILITY employees or agent
FACILITY or its employees, subcontractors, or agents acting
acting within the scope of this Agreement, or from the activities
under this Agreement.
or omissions of OHSU or Its employees, subcontractors, or
agents acting under this Agreement.
8. INSURANCE
If OHSU's Trainees are being trained at FACILITY.
1 If FACILITY's Trainees are being trained at OHSU:
OHSU shall be responsible to provide Professional Liability
FACILITY shall be responsible to provide Professional Liability
Insurance coverage to OHSU's Trainees while Trainees are
Insurance coverage to FACILITY's Trainees while Trainees
receiving clinical instruction at FACILITY.
are receiving clinical instruction at OHSU.
FACILITY shall secure at its own expense, and keep in effect
OHSU shall secure at its own expense, and keep In effect
during the term of this contract, Premises and Professional
during the term of this contract, Premises and Professional
Liability insurance with a minimum limit of $1,000,000 per
Liability insurance with a minimum limit of $1,000,000 per
occurrence and $3,000,000 annual aggregate.
occurrence and $3,000,000 annual aggregate.
H: Prectice DevelopmentlMy Documents - PDIDeschutes County Helath Dept. agr 04.doc Page 3 of 0
OHSU Contract # AFF -2005-0097
replaces N-1996-0025
9. WORKER'S COMPENSATION INSURANCE
f OHSU's Tralnejs pre being trained at FACILITY:
1 /f FACILITY's Trainees are belnn trained ai(OHSU:
OHSU and all employees working under this Agreement are
FACILTY and all employees working under this Agreement are
subject employees under the Oregon Worker's Compensation
subject employees under the Oregon Worker's Compensation
Law. OHSU agrees that it shall comply with ORS 656.017,
which requires employers to provide worker's compensation
Law. FACILITY agrees that it shall comply with ORS 656.017,
which requires employers to provide worker's compensation
coverage to all subject employees. Under ORS 656.046,
coverage to all subject employees. Under ORS 656.046,
OHSU's Trainees (unpaid professional students of an Oregon
FACILITY's Trainees qualify for Worker's Compensation
university) do not qualify for Worker's Compensation.
coverage only If FACILITY is an Oregon community college or
school under the govemance of the State Board of Educatior.
10. SEVERABILITY
The parties agree that if any term or provision of this Agreement is declared by a court of competent jurisdiction to be Illegal cr in
conflict with any law, the validity of the remaining terms and provisions shall not be affected, and the rights and obligations of the
parties shall be construed and enforced as If the contract did not contain the particular term or provision held to be invalid.
11. TAX COMPLIANCE CERTIFICATION
OHSU hereby affirms, under penalty of perjury, as provided In ORS 305.385(6), that to the best of OHSU's knowledge OHSU is not
in violation of any of the tax laws described In ORS 305.380(4).
FACILITY hereby affirms, under penalty of perjury, as provided In ORS 305.385(6), that to the best of FACILITY's knowledge
FACILITY is not in violation of any of the tax laws described in ORS 305.380(4).
12. WAIVER
The failure of either party to enforce any provision of this agreement shall not constitute a waiver by that party of that or any other
provision.
13. GOVERNING LAW
This contract shall be govemed by and construed In accordance with the laws of the State of Oregon. Any claim, action, or suit
between OHSU and Contractor that arises out of or relates to performance of this contract shall be brought and conducted solely
and exclusively within the Circuit Court for Washington County, for the State of Oregon.
Provided, however, that if any such claim, action or suit may be brought only in a federal forum, It shall be brought and conducted
solely and exclusively within the United States District Court for the District of Oregon.
14. COMPLIANCE WITH APPLICABLE LAW
OHSU and FACILITY shall comply with all federal, state, county and local laws, ordinances, and regulations applicable to tnis
contract. Unless exempted under the rules, regulations and relevant orders of the Secretary of Labor, 41 CFR, Ch. 60, the parties
agree to comply with all provisions of Executive Order No. 11246 as amended by Executive Order No. 11375 of the President of the
United States dated September 24, 1965, Title VI of the Civil Rights Act of 1964 and Section 504 of the Rehabilitation Act of 1973
as Implemented by 45 CFR 84.4, which states, "No qualified person shall, on the basis of handicap, be excluded from participation
In, be denied benefits of, or otherwise be subjected to discrimination under any program or activity which received or benefits from
Federal financial assistance." Both parties will also comply with all applicable rules, regulations and orders of the Secretary of
Labor concerning equal opportunity in employment and the provisions of ORS Chapter 659.
15. FEDERAL AND STATE PROGRAM ELIGIBILITY
FACILITY and OHSU each represents and warrants that it is not excluded from participation, and is not otherwise Ineligible to
participate In a Federal health care program, as defined In 42 U.S.C. Section 1320a-7b(f) or In any other govemment payment
program. In the event either FACILITY or OHSU is excluded from participation, or becomes otherwise ineligible to participate in any
such program during the term, the excluded party will notify the other party and each Participant in writing within three (3) days after
such event. Upon the occurrence of such event, whether or not such a notice Is provided, this Agreement will be immediately
terminated without penalty to the terminating party.
HAPrectko DevelopmenNNy Documents - PD1Deschutea County Heteth Dept agr 04.doc Paye 4 of 6
OHSU Contract # AFF -2005-0097
replaces N-1996-0029
16. FORCE MAJEURE
OHSU shall not be liable for any failure or delay in performing its obligations hereunder, or for any loss or damage resulting
therefrom, due to:
a) Acts of God, acts of government, war, not, embargoes, acts of civil or military authorities, fire, flood, accidents, strikes,
epidemics or unusually severe weather affecting either party,
b) Causes beyond their control and which are not foreseeable or causes beyond the reasonable control of noir
subcontractors which are not foreseeable.
17. ASSIGNMENT
Neither party shall assign or transfer its Interest In this Agreement without the express written consent of the other party. Neither
party shall enter Into any subcontracts for any of the work scheduled under this contract without obtaining prior written approval f m
the other party.
18. HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT i Business Associate Requirements
If Contractor's performance under this contract involves or requires the disclosure to or use by Contractor of OHSU's "Individually
Identifiable Health Information" (as that term is defined by the Health Insurance Portability and Accountability Act and regulations
promulgated pursuant thereto ("HIPAA"J), then the following provisions apply:
a) Contractor will use and disclose Individually Identifiable Health Information received from, or created or received by
Contractor on behalf of, OHSU in the course of its performance under this contract ("PHI") only as required for such
performance, as permitted herein or as required by law, and Contractor will use all appropriate safeguards to prevent any
use or disclosure of PHI other than as allowed in this contract. All PHI (In whatever form) is the exclusive property of
OHSU.
b) Contractor shall not, and shall ensure that its directors, officers, employees, contractors and agents (collectively,
"Contractor Representatives") do not, use or disclose PHI in any manner constituting a violation of 45 CFR §160 and 164
("Privacy Standards") if done by OHSU.
c) Contractor agrees that any request to OHSU for disclosure of PHI shall be limited to the minimum necessary to accomplish
Contractor's purpose under this contract.
d) Contractor shall immediately notify OHSU In writing of any use or disclosure of PHI other than as allowed by this contract,
and, to the extent practicable, shall mitigate any harmful effect of such use/or disclosure.
e) Contractor shall ensure that each of the Contractor Representatives having access to PHI, agree to comply with the
restrictions and conditions of this paragraph 18.
f) If Contractor maintains Records for OHSU that are a part of OHSU's Designated Record Set ("DRS"), Contractor will. (I)
within 10 days of a request from OHSU for access to an Individual's PHI contained In the DRS, provide copies of such PHI
to OHSU; (il) within 10 days of a request from OHSU for an amendment of an identified individual's PHI in a DRS, make
available the PHI for amendment and Incorporate such amendment into PHI maintained by Contractor as required by the
Privacy Standards; and (iii) within 5 days of Contractor's receipt from an Individual of a request for access to PHI or for an
amendment of PHI, forward that request to OHSU in writing.
9)
Within 10 days of notice from OHSU that OHSU has received a request for an accounting of disclosures of an Individual's
PHI, Contractor shall make available to OHSU such information in Contractor's possession and as necessary for OHSU to
make the accounting required by 45 CFR §164.528, Including: (I) the date of the disclosure occurring after April 16, 2003,
but no more than 6 years prior to the date of the request, (11) the name and if known the address of the entity or person who
received the PHI, (ili) a brief description of the PHI disclosed, and (iv) a brief statement of the purpose and basis of the
disclosure, (collectively, "Disclosure Information"). If the request for an accounting of disclosures of PHI is delivered to
Business Associate, then Business Associate shall within 5 business days of receipt, forward such request to OHSU,
Business Associate hereby agrees to implement an appropriate record keeping process to enable it to comply with the
requirements of this subparagraph 18, g, and shall maintain a record of Disclosure Information for a period of 6 years from
the date of each disclosure. Contractor may elect to satisfy its obligations under this subparagraph 18, g. by entering ;he
information required by this subparagraph 18, g. directly Into an OHSU web -based accounting -of -disclosures !)oi
("Accounting of Disclosures System"). To so elect, Contractor must contact the OHSU Privacy Officer at (503-494-8849),
obtain access to the Accounting of Disclosures System and thereafter input Into that system, all information required un ier
this subparagraph 18, g. in conformance with instructions provided by OHSU.
h) Contractor shall make Its intemal practices, books and records relating to the use and disclosure of PHI available to he
Secretary for purposes of determining OHSU's compliance with the Privacy Standards.
H:1Practice Development%Cy Documents - PD1Deschutes County Helath Dept. agr 04.doc Page 5 of 6
OHSU Contract # AFF4005.0097
replaces N-1996-0029
I) Compliance with Security Regulations. Beginning no later than April 21, 2005 and continuing thereafter, with respect to any
electronic PHI that Business Associate creates, receives, maintains, or transmits, Business Associate shall:
(1) Implement Administrative Safeguards, Physical Safeguards and Technical Safeguards that reasonably and
appropriately protect the confidentiality, integrity and availability of the electronic PHI, as required by the Se ,unity
Standards;
(2) Ensure that any agent, including a subcontractor, to whom it provides such electronic PHI, agrees to implement
reasonable and appropriate safeguards to protect it;
(3) Report to OHSU any attempted or successful unauthorized access, use, disclosure, modification, or destruction of
electronic PHI, or interference with system operations in an Information System, of which It becomes aware; and
(4) Authorize termination of the Existing Agreements, if OHSU determines that the Business Associate has violated a
material term of this Agreement.
Capitalized terms used in this paragraph (1) shall have the meaning given them In the Security Standards.
OHSU may terminate this contract upon ten (10) days written notice to Contractor if OHSU determines, in Its sole discretion,
that Contractor has violated a material term of this paragraph 18 and such breach is not cured within such ten (10 day
period. Upon termination of this contract for any reason, Contractor shall either retum or destroy all PHI maintained by
Contractor in any form retaining no copies. If the retum or destruction is not feasible, Contractor shall extend the
protections of this paragraph 18 to such PHI and such PHI shall be used or disclosed solely for such purpose(s) that snake
the retum or destruction of such PHI infeasible.
k) Notwithstanding any limitation on damages contained herein, Contractor shall Indemnify and hold OHSU harmless from and
against any and all liability and costs, including attorneys' fees, arising out of or related to a breach of this paragraph 18 by
Contractor, its agents or subcontractors.
I) Contractor agrees to amend this contract as necessary to allow each party to comply with (I) the Privacy Standards, (ii) the
Standards for Electronic Transactions (45 CFR parts 160 and 162) and (iii) the Security Standards, (collectively, the
"Standards"), as they are amended from time to time by the Secretary.
m) Capitalized terms used in this paragraph without definition, have the meanings assigned to them in the Privacy Standards.
The terms and conditions of this paragraph 18 shall supersede any conflicting or Inconsistent terms in the contract.
1)
19. MERGER
THIS AGREEMENT CONSTITUTES THE ENTIRE AGREEMENT BETWEEN THE PARTIES. THERE ARE NO
UNDERSTANDINGS, AGREEMENTS, OR REPRESENTATIONS, ORAL OR WRITTEN, NOT SPECIFIED HEREIN REGARDING
THIS AGREEMENT. NO AMENDMENT, CONSENT, OR WAIVER OF TERMS OF THIS AGREEMENT SHALL BIND EITHER
PARTY UNLESS IN WRITING AND SIGNED BY ALL PARTIES. ANY SUCH AMENDMENT, CONSENT, OR WAIVER SHALL
BE EFFECTIVE ONLY IN THE SPECIFIC INSTANCE AND FOR THE SPECIFIC PURPOSE GIVEN. BY THE SIGNATURE
BELOW OF THEIR AUTHORIZED REPRESENTATIVES, BOTH PARTIES ACKNOWLEDGE HAVING READ AND
UNDERSTOOD THE AGREEMENT AND AGREE TO BE BOUND BY ITS TERMS AND CONDITIONS.
In Witness Whereof, the parties hereto have caused this Agreement to be executed by their respective duly authorized
representatives as of the date last below written.
OREGON HEALTH & SCIENCE UNIVERSITY
An Oregon Public Corporation
Christyne B : i, : n
Contracts Coordinator
1410
Date
Kathleen Potempa, DNSc, RN, F
Dean, School of Nursing
Date
DESCHUTES COUNTY HEALTH DEPARTMENT
.144)2
Dan Rettyaocd
Director
0-a7-01-,
Date
Name:
Title:
H:1Pract ce DeveiopmenNAy Documents - PD1Deschutes County Heiath Dept. agr O4.doc Page 0 of 6
Date